Founded in 1826, Yale-New Haven Hospital (YNHH) is a non-profit, 1,008-bed tertiary care hospital that receives national and international referrals. The hospital includes Smilow Cancer Hospital at Yale-New Haven, Yale-New Haven Children’s Hospital and Yale-New Haven Psychiatric Hospital. An article released by U.S. News & World Report, “America’s Best Hospitals”, ranked YNHH among the best hospitals in the United States. The hospital is accredited by The Joint Commission and in May of 2011, the American Nurses Credentialing Center granted YNHH Magnet Recognition, which signifies nursing excellence and recognized collaboration between nurses and members of the healthcare team. Only six percent of American hospitals have received this honor. YNHH prides itself on its mission, which focuses on community service, teaching, research and patient care. In addition to providing quality medical care to patients and families, YNHH is the second largest employer in the New Haven area, relying on the skills of nearly 9,000 employees and a combined medical staff of about 3,600 university and community physicians practicing in more than 100 specialties.
YNHH’s Heart and Vascular Center offers a wide range of procedures for cardiovascular conditions, and is consistently ranked among the best in the nation by U.S. News & World Report. Services include diagnostic and interventional procedures, cardiothoracic surgery, electrophysiology and interventional radiology. The Heart and Vascular Center (HVC) includes a women’s heart program, a non-invasive cardiovascular imaging department, a cardiac rehabilitation program and five inpatient units:
- A 14-bed cardiac intensive care unit;
- An 18-bed cardiothoracic intensive care unit;
- A 14-bed cardiac surgical step-down unit;
- A 26-bed medical cardiology unit, and;
- A 25-bed progressive care unit.
The Heart and Vascular Center also includes six interventional labs, three state-of-the-art electrophysiology (EP) labs, including two biplane fluoroscopy rooms, and pre-procedure and post-procedure recovery areas. Five operating room suites are designated for cardiac use.
The cardiac cath lab features five procedure rooms, including a Philips pediatric hybrid lab and a Siemens Artis Zeego Multiaxis Robotic System.
HVC procedural area staff, composed of the cath lab, EP lab and interventional radiology (IR) lab, includes:
- Six advanced practice registered nurses (APRNs);
- Two physician assistants (PAs);
- A service line educator;
- A scrub educator;
- 67 registered nurses (RNs);
- 39 radiologic technologists (RT[R]s);
- Three clinical service associates (CSAs), who schedule all out-patient cardiac cath, EP and IR procedures;
- Two patient care associates (PCAs);
- Two operating room aides (ORAs);
- An inventory control lead – a shared position between the Cath/EP/IR labs.
Staff experience ranges from one to 40 years. There are 24 attending physicians, three interventional fellows and a number of cardiology fellows who rotate monthly in the cath lab. A practice manager, who is an RN, oversees the entire procedural area. One manager is in charge of clinical operations for the cath and EP labs, and another manager heads IR operations. An assistant patient services manager is in charge of nursing for the entire HVC procedural area. As one of the nation’s leading providers of heart and vascular health services, YNHH’s Heart and Vascular Center is a national pioneer in developing new heart treatments and therapies. Our reputation is one of the reasons that we are consistently ranked among the top 100 hospitals for cardiac care in the nation.
What procedures are performed in your cath lab?
The HVC cath lab performs diagnostic and interventional procedures. In 2011, the cath lab performed:
- 3,166 cardiac caths (adult and pediatric) procedures;
- 1,360 angioplasties;
- 268 cardiac biopsies;
- 337 peripheral vascular procedures (diagnostic/therapeutic procedures for iliac, superficial femoral, renal, carotid and subclavian artery disease);
- nine percutaneous valve replacements.
Intra-aortic balloon pumps (IABP), transvenous temporary pacemakers and pericardial taps are also performed. Pressure wires are used in performing fractional flow reserve (FFR), and intravascular ultrasound (IVUS), thrombectomy, and rotational artherectomy are also utilized by the HVC.
What percentage of your patients is female?
Thirty-five percent of the patients are female.
What percentage of your diagnostic caths is normal?
Twenty-four percent of the diagnostic cardiac caths are normal, meaning less than a 10 percent occlusion.
Do any of your physicians regularly gain access via the radial artery?
Yes, physicians regularly gain radial access. Approximately 40 percent of the cases are performed via radial access.
Who manages your cath lab?
The cath lab is run by Senior Manager Marcie Scalia, RT(R), BS. Marcie oversees the daily operations and budgets of both the cardiac cath and electrophysiology labs. Michael Cleman, MD, and Craig Thompson, MD, serve as medical directors of the adult cath labs. Jeremy Asnes, MD, is the director of the pediatric cath lab.
Do you have cross-training? Who scrubs, who circulates and who monitors?
Yes, we have cross-training in our labs. Cardiac fellows scrub in and specially scrub trained technologists and nurses assist in procedures as well. Both RNs and technologists circulate. RTs obtain and set up equipment, and RNs monitor and document the procedures. Some technologists are trained to assist with documentation. An RN reviews all documentation prior to the conclusion of the case.
Does an RT have to be present in the room for all fluoroscopic procedures in your cath lab?
In all of our cath labs, an RT is present during fluoroscopic procedures.
Which personnel can operate the x-ray equipment (position the II, pan the table, change angles, step on fluoro pedal) in your cath lab?
The RTs in the cath lab position the II, pan the table, change angles and step on the fluoro pedal. At times, physicians control the fluoro pedal during lengthy procedures, such as chronic total occlusions (CTOs), so that the technologist can get any additional equipment needed for the procedure.
How does your cath lab handle radiation protection for the physicians and staff?
All staff hired to work in the cath lab are required to take a radiation safety class and pass a written test during their orientation. Annually, technologists and nursing staff must complete an on-line training course on radiation protection. Periodic lectures are also given to the cath lab staff by the YNHH radiation safety officer. All staff working in the cath labs wear radiation safety badges, which are exchanged monthly and monitored by the YNHH radiation safety department. Monthly dosimetry reports are posted for all to view.
What are some of the new equipment, devices and products introduced at your lab lately?
In March 2011, YNHH installed two new Siemens Artis Zee ceiling-mounted cath labs. In April 2012, a new Siemens Zeego system was installed. The Zeego incorporates an industrial robot that allows the operator to move the C-arm to almost any position around the patient.
New products include: Medtronic’s Resolute Integrity drug-eluting coronary stents, Abbott’s Prime drug-eluting Xience coronary stents, Bard’s Ultraverse .014 peripheral balloons, and Abbott’s Armada .014 and .035 peripheral balloons. New devices include: Gore’s Flow Reversal System for carotid stenting and the EKOS (EkoSonic Endovascular System), used for clot-busting in peripheral and pulmonary arteries. The HVC is currently trialing the Exoseal, a vascular closure device by Cordis, and is also implanting Edwards’ Sapien, and Medtronic’s Melody and CoreValve percutaneous valves.
How does your lab communicate information to staff and physicians to stay organized and on top of change?
HVC Procedures has daily morning safety huddles where managers inform and review the schedule, staffing and important updates with all staff. In addition to huddle, there are monthly staff meetings and daily email communications. The service line educator keeps staff informed of any new hospital-wide or HVC policy changes, and new equipment trials. Physicians, leadership, managers and staff attend a monthly HVC Operations Council meeting to review, plan and implement current and future initiatives.
How is coding and coding education handled in your lab?
The cath lab manager is responsible for ensuring that there are appropriate billing codes for procedures. The coding department at Yale-New Haven Hospital notifies the section manager of CPT code changes and revisions on a regular basis. Technologists use a detailed encounter form that they helped design to check off procedures performed in the cath labs so that they can be billed appropriately. A dedicated coding expert reviews each encounter form prior to billing to ensure accuracy.
Who pulls the sheaths post procedure, both post intervention and diagnostic?
A physician, either an attending or a fellow, pulls the sheaths in the cath lab. On the recovery or patient care units, a cardiology fellow pulls the sheaths.
Where are patients prepped and recovered (post sheath removal)?
Inpatients are usually prepped and recovered on their units by their nurses. Outpatients are prepped in the HVC pre-procedure area.
After the procedures, patients who are being discharged or who are awaiting for an admission bed are transported to the HVC post-procedure recovery area. Any patient who has received an intervention is admitted to a telemetry unit overnight. Both the pre- and post-procedure areas are shared with EP and IR patients, and are run by HVC procedural nurses and PCAs.
If a patient from a non-Heart and Vascular Center inpatient care unit undergoes an intervention or receives a TR Band (Terumo), he/she must recover on a unit in the HVC. Lifestar activations (our critical care helicopter service), critically ill patients and those with intra-aortic balloon pumps or Swan-Ganz catheters are cared for in the cardiac ICU or cardio-thoracic ICU.
Hemostasis is obtained in the lab prior to transporting the patient. Use of manual pressure or a vascular closure device depends on the type of access (arterial or venous), the patient’s blood pressure and the location of the arterial stick.
What is your lab’s hematoma management policy?
If a hematoma develops, an RN applies manual pressure, and a cardiology fellow and an attending are notified immediately. A physician obtains hemostasis and applies a dressing and compression device as required.
Per hospital policy, all post-arteriotomy patients have their site assessed and vital signs monitored and documented every 15 minutes x 4, then every 30 minutes x 2, and then every hour x 4, and then if no problems occur, every 4 hours.
How is inventory managed at your cath lab? Who handles the purchasing of equipment and supplies?
Employees of Owens & Minor, Inc., in conjunction with the inventory control lead, handle inventory. The section manager, with input from physicians, purchasing and senior administration, purchases equipment. The inventory control lead works closely with the purchasing department to ensure that staff has the supplies needed along with the best pricing. A formulary committee must approve all new products before they are introduced into the labs.
Has your cath lab recently expanded in size and patient volume?
Within the past year, the cath lab expanded the cardiac swing lab into two separate labs. In addition, we increased our staff to include a PCA, an OR aide, four technologists and six RNs. We also added three cardiology attending physicians within the last three years: a specialist in chronic total coronary occlusions, a specialist in peripheral vascular treatment and a specialist in pediatrics. One vascular surgeon is now performing peripheral interventions in the cath lab. We are also caring for a larger percentage of patients requiring carotid and peripheral vascular procedures, as well as percutaneous valve replacements. We expect volume to increase over the next few years, due to the increase in peripheral vascular procedures, valve replacements and research trials.
Can you tell us about your hybrid lab?
Yes, we have a pediatric hybrid cath lab that is also used for adult cases. The hybrid lab includes a Philips Allura Xper FD10/10 biplane cardiovascular x-ray system. The system has two C-arms (lateral/AP), so it gives twice the information with one single injection. It also provides exceptional visualization while minimizing x-ray dosage (see room photo on page 24, bottom left).
The pediatric cath lab is used for pediatric and adult diagnostic and interventional cardiac and electrophysiology procedures, as well as operative procedures if the need arises.
Can you tell us about your lab’s clinical research?
Yes, we are involved in a great deal of clinical research. We are participating in the CoreValve trials, CHOICE trial (comparing transcatheter heart valves in high risk patients with severe aortic stenosis), TRYTON (evaluating the safety and effectiveness of the Tryton side branch stent used with DES in treatment of de novo bifurcation lesions in the main branch and side branch in native coronaries), and the LEVANT I trial (the Lutonix paclitaxel-coated balloon for the prevention of femoropopliteal restenosis), to name a few.
Can you share your lab’s average door-to-balloon (D2B) times and some of the ways employees at your facility have worked together to keep D2B times under the mandated 90 minutes?
Currently, our average door-to-balloon time is 68 minutes. When staff members are on call, they are required to arrive within 30 minutes of the page (according to hospital policy). If an activation occurs during normal business hours, staff work together to find the first room available to prepare for the patient’s arrival.
We are a part of the American College of Cardiology’s D2B Alliance. We are also a Cycle III Chest Pain Center-accredited hospital. This is the highest designation from the Society of Chest Pain Centers.
Who transports your STEMI patients to the cath lab during regular hours and off hours?
During all hours, our STEMI patients are brought to the lab by our Emergency Department (ED) staff, from the field by the Emergency Medical Service (EMS), or from an outlying hospital by Life Star.
How does your lab handle call time for staff members? Is there a particular mix of credentials needed for each call team?
Our call time is divided equally among the 16 technologists and 22 RNs. Our call team consists of one technologist, two RNs, one interventional cardiology fellow, one attending, and often one first- or second-year cardiology fellow. Call begins at 8 pm, Monday-Friday, and ends at 8 am the next day; weekend coverage is 24 hours on Saturday, and Sunday from 8 am to 8 am.
Within what time period are call team members expected to arrive to the lab after being paged?
For activations, the on-call team must arrive within 30 minutes after being paged, in accordance with hospital policy.
What do you do when the call team is already busy doing a procedure and a STEMI comes into the ED?
In the case of a double activation off-hours, an RN and/or RT will call other staff members to see if they are available to come into work. Since our call team is composed of two RNs, one of the RNs will begin setting up another lab for the STEMI if the current case permits them to do so.
What other modalities do you use to verify stenosis?
Modalities used to identify stenosis are computed tomography angiography and stress echocardiography. We measure FFR for coronary lesion assessment, and employ IVUS in both coronary and peripheral vessels to assess stenosis.
What measures has your cath lab implemented in order to cut or contain costs?
To help contain cost and assist with charge capture, we implemented QSight, an Owens & Minor web-based clinical inventory management system. QSight gives us visibility of usage and on-hand inventory. The system allows us to scan out products used for procedures. QSight interfaces with our billing system and the implementation of the system has helped to enhance our charge capture. We saved money by lowering annual inventory spending, minimizing expiration, and reducing inventory on the shelf by setting par levels.
We continually look for ways to cut costs by working on supply and contract management, with a huge focus on consignment rather than owned inventory. Our Inventory Lead works closely with the physicians to review supply usage so that we do not continue to bring in supplies that we no longer use in the lab.
We employ waste management strategies for fluids and medications. Yale-New Haven Hospital has a new sustainability coordinator that is evaluating ways we can enhance our recycling in order to help the environment and reduce costs at the same time.
What quality control/quality assurance (QA) measures are practiced in your cath lab?
Each morning, we perform routine preventative maintenance checks on equipment such as defibrillators, life packs, balloon pumps, temporary pacemakers, etc. RNs check code carts, emergency medications and equipment at the start of each day. RTs are responsible for the daily and weekly quality assurance checks on our Avox equipment. QAs on i-STATs are managed by our point-of-care testing coordinator. A physicist tests all procedure rooms on an annual basis; we also have preventative maintenance performed as per manufacture’s recommendations.
How are you recording fluoroscopy times and dosages?
Each lab’s fluoroscopy equipment records the time and the total dosage in each case. This time is recorded in the patient’s medical record. We also complete extended fluoroscopic time forms if we use more than 60 minutes of fluoro time in one procedure. These forms are then sent to our radiation safety officer.
Who documents medication administration during the case?
The individual monitoring the case documents the medication administration. An RN documents the case 90 percent of the time. The other times, an RT performs the documentation. RNs review the report and all documentation upon completion of the case.
Do you use the American College of Cardiology National Cardiovascular Data Registry (ACC-NCDR) or any other outside data collection registry?
Yes, we participate in the CathPCI Registry. We are also part of the ACC-NCDR IMPACT Registry™ (IMproving Pediatric and Adult Congenital Treatment). The IMPACT Registry assesses the prevalence, demographics, management and outcomes of pediatric and adult patients with congenital heart disease who are undergoing diagnostic catheterizations and catheter-based interventions.
Has your institution formed an alliance with others in the area?
The HVC department at YNHH has developed strong relationships with both university and community physicians, sharing best practices and enhanced quality and safety systems. The cath lab prides itself on service excellence and creating a great first impression. We have worked very hard over the last year to improve patient flow and throughput. Daily operation reports track all procedure start times and room utilization. We have improved our scores in these areas. HVC’s Press Ganey and HCAPS scores are above threshold levels. These metrics keep us competitive in today’s market.
Yale New Haven Health System is comprised of Yale-New Haven Hospital, Bridgeport Hospital and Greenwich Hospital. Non-STEMI patients from Greenwich are transferred regularly for cardiac interventions at Yale-New Haven. Advanced heart failure patients from the other hospitals are also transferred to Yale-New Haven Hospital when they require ventricular assist devices or other services only provided here.
YNHH has a referral system called Y-access where physicians can call one phone number to transfer a patient to our hospital. Patients are referred from hospitals throughout the state, New York and Rhode Island. One of our peripheral vascular interventional cardiologists, Dr. Carlos Mena, is actively recruiting patients. This year, he has presented at local and international conferences in China and Brazil. Yale-New Haven is establishing itself as a destination hospital and HVC Procedures is instrumental in providing the heart and vascular procedures for those patients seeking care here.
Chief of Pediatrics William Hellenbrand, MD, is collaborating with Connecticut Children’s Hospital to establish a new statewide program in congenital heart surgery.
How are new employees oriented and trained at your facility?
Each new YNHH employee has a full one-day hospital orientation. Any technologist or nurse transferring to the cardiac cath lab from another department within the hospital is paired with a preceptor. All nurses must have at least two years of critical care experience and undergo a twelve-week orientation. Technologists must have at least two years of experience in their primary field of discipline and are trained by a cath lab technologist for six months. Throughout the technologist’s training, the section manager, preceptor, and new staff member meet to complete a competency checklist. Newly hired RNs meet with their preceptor, service line educator and assistant patient services manager to monitor progress and assure the completion of a written critical care test, an on-line education course from the American Association of Critical Care Nurses, and a unit-specific competency-based orientation manual. All new staff members are required to attend a radiation safety seminar and to complete on-line laser safety training.
What continuing education opportunities are provided to staff members?
Yale Medical School cardiology professors and fellows, as well as visiting physicians, give educational lectures, Grand Rounds and case studies several times a month. We have the opportunity to attend conferences in the hospital or travel to national events. RT(R)s must acquire 24 CEUs every two years and our vendors provide access to online CEU activities. Product representatives give “lunch and learn” in-services on new products, equipment and procedures that are being introduced into the labs, and CEUs are often provided.
In April, HVC physicians gave an eight-hour seminar open to the public on cardiovascular treatment modalities. Many of our staff attended and CEUs were provided.
How is staff competency evaluated?
For technologists, an annual competency form is completed by the Cath Lab Cluster Lead Technologist, who works and observes staff on a daily basis. Some competencies also require a one-on-one return demonstration. For nurses, the hospital provides skills fairs three times a year. Nurses are required to attend one fair to complete the hospital-selected and Heart and Vascular Center-specific competencies, as well maintain their advanced cardiac life support (ACLS) certification.
Does your lab have a clinical ladder?
Yes, we do have a clinical ladder for technologists and nurses. Technologists have two tiers: Tech I and Tech II. There is also a trainee position for technologists with no cath lab experience. Nurses have four tiers: CNI, CNII, CNIII and CNIV; most of our nurses are CNII and CNIII. We do have one CNIV.
Do you have flextime or multiple shifts?
Our technologists work 8-hour days Monday-Friday; our nursing staff performs self-scheduling and work shifts of 8-, 10- or 12 hours per day, Monday-Friday. Scheduled hours range from 7 am until 8 pm. When cases are scheduled earlier or run after 8 pm, staff adjusts their schedules so the call team is free for activations.
How do you handle vendor visits to your lab?
Vendors are only allowed in the lab when they are needed to support procedures. Our physicians or vendors notify the inventory control lead of their visit. Vendors register in the Vendor Mate system (located at the entrances to the hospital) each time they come to YNHH. Once they log in, the system prints out a temporary name badge, which must be worn at all times.
Has your lab recently undergone a national accrediting agency inspection?
Yale-New Haven Hospital is a Cycle III Chest Pain Center-accredited hospital. This is the highest designation from the Society of Chest Pain Centers. Currently, we are in the process of seeking recertification.
In addition, Yale New Haven Hospital is one of a handful of programs in New England certified by The Joint Commission to implant left ventricular assist devices into patients with end-stage heart failure as a permanent or destination therapy.
In May 2011, YNHH received Magnet Recognition after documentation was accepted and the entire hospital, including the cath lab, was inspected by surveyors from the American Nurses Credentialing Center.
We recommend that other labs ensure that there is a list of lead aprons and that each apron is labeled with a unique identifier. It is necessary to have policy and procedures for checking lead aprons. A policy and procedure for radiation safety badges, and who checks to see if badges are turned in should be in place as well.
Where is your cath lab located in relation to the operating room (OR) and emergency department (ED)?
Our cath lab is located on the second floor of the main hospital. The ED is on the first floor of the main hospital and the OR is on the third floor of the main hospital.
What trends have you seen in your procedures and/or patient population?
We are doing more radial access, peripheral vascular cases, and percutaneous valve placements. In regards to trends in patient population, there has been a decrease in bleeding due to the increased use of the radial artery approach.
What is unique and innovative about your cath lab and staff?
In the history of the Heart and Vascular Center at YNHH, we have welcomed an impressive list of pioneering cardiology specialists who have led the way in developing cardiac diagnostic tools and treatments to help both adults and children with heart disease. For example, two of our pediatric cardiologists pioneered the repair of some congenital heart defects in the cardiac cath lab, allowing patients to avoid open-heart surgery. Our pediatric interventional cardiologists also performed some of the first hybrid procedures with pediatric congenital heart surgeons. Working together as a team, we make history with these new and innovative procedures.
We also have a number of physicians who are directly involved in clinical research, and who travel both locally and internationally to learn about the latest treatments, tools and devices in heart and vascular care, and to give lectures on their experiences and findings.
What makes us is unique is that we are truly a family; we are team players and we work very hard to ensure that our patients receive the best care possible. We are often told by service representatives, vendors, and our patients that we have “something special.”
Is there a problem or challenge your lab has faced?
For the past year, three of our five cath labs have undergone construction. Our managers worked closely with the physicians, schedulers and staff to accommodate our patient volume while being down 1-2 labs. Staff adjusted their own schedules to meet the increased demands and the various needs of patients and families. When the pediatric cath lab was not in use, we shifted adult cases to that lab. We also used a small IR room with a C-arm to perform certain cardiac procedures to help with patient throughput.
What’s special about your city or general regional area in comparison to the rest of the U.S.? How does it affect your “cath lab culture”?
Yale-New Haven Hospital is located in the downtown area of New Haven, Connecticut. YNHH is the primary teaching hospital for Yale School of Medicine, one of the eight Ivy League schools in the U.S. and the number-three best college in the country. We have some of the brightest individuals working in heart and vascular care to help inspire better solutions to the intricacies of the heart, and to keep us up to date with the latest clinical research, trials, and technology. We also have a diverse group of staff with advanced degrees and training in specialties such as cardiac care and patient education.
Located on Long Island Sound between New York City and Boston, Yale-New Haven Hospital provides care to a diverse population. From the “Gold Coast” of Connecticut to inner city New Haven, YNHH’s pledge to provide quality patient- and family-centered care, teaching, research and innovation to all individuals, is evidenced every day in our cath lab, as we treat the eighty-five year old with heart failure as well as the newborn with pulmonary valvular disease. We take the community portion of the hospital’s mission statement very seriously. Each year, we sponsor families for the holidays. Last year, we raised more than $2,000 dollars and hundreds of toys for “Toys for Tots.” We participate in the annual American Heart Association’s Heart Walk, and some of our nurses volunteer to talk about preventing heart disease at the educational events sponsored by the Women’s Heart Program.
Yale New Haven Hospital is a great place to work. In 2011, we were recognized by U.S. News & World Report and received Magnet status. We also received awards from:
- Working Mother magazine, as one of the Best 100 Places to Work.
- Modern Healthcare Studer Group as a Best Place to Work.
- National Association for Overall Executives — Top Company for Executive Women.
- The Coalition for Working Families, in Recognition of Exceptional Participation as an Official Volunteer Individual Tax Assistance Site.
- Smilow Cancer Hospital at YNHH received the Green Building Award, Commercial and Institutional Award of Merit from the Connecticut Green Building Council.
- In 2012, the Ticker Survey National Research Corporation noted YNHH as New Haven’s Most Preferred Hospital for Overall Quality and Image.
HVC procedural staff members are proud to be a part of a leading health care system in America. We look forward to embracing the continued growth of our department and upcoming changes, including the acquisition of a new hospital this summer and the arrival of the Epic EMR in February 2013.
The Society of Invasive Cardiovascular Professionals (SICP) has added two questions to our spotlight:
Do you require your clinical staff members to take the registry exam for Registered Cardiovascular Invasive Specialist (RCIS)? Does staff receive an incentive bonus or raise upon passing the exam?
Our staff members are not required to take the registry exam for RCIS. If a staff member passes the exam, the hospital will reimburse the examination fee and reward the staff member with a special achievement award.
Are your clinical and/or managerial team members involved with any professional organizations that support the invasive cardiology service line, such as the SICP, ACVP or regional organizations?
We have one nurse, our educator in the lab, who belongs to the SICP. Several of our nurses are members of the American Association of Critical Care Nurses and the Association of Radiology Imaging Nurses.
The Yale New-Haven Heart and Vascular Center can be contacted via Marcie Scalia, Senior Manager, HVC Cardiac Procedure Labs, at Marcie.Scalia@ynhh.org.